=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548593346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPLETE COUNSELING SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2009
-----------------------------------------------------
Last Update Date | 09/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7200 W BELL RD H107
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-8529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-291-0945
-----------------------------------------------------
Fax | 623-398-7771
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7200 W BELL RD H107
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-8529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-291-0945
-----------------------------------------------------
Fax | 623-398-7771
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MR. MICHAEL CURTIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-291-0945
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW2394
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------